Permit CIT OF TIGARD MECHANICAL PERMIT
I A , DEVELOPMENT SERVICES PERMIT #: MEC2003 -00612
+ AI 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/17/03
PARCEL: 1S134CB-09100
SITE ADDRESS: 11145 SW 123RD PL
SUBDIVISION: ANTON PARK ZONING: R -7
BLOCK: LOT: 053 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm: GAS OUTLETS: 1
Remarks: Install gas stove and gas piping.
Owner: FEES
RATHKE, KAREN AN NE Description Date Amount
11145 SW 123RD PL
TIGARD, OR 97223 [MECH] Permit Fee 10/17/03 $72.50
[TAX] 8% StateTax 10/17/03 $5.80
Phone: Total $78.30
Contractor:
CASCADE CHIMNEY CARE
P.O. BOX 775
ESTACADA, OR 97023 REQUIRED INSPECTIONS
Phone: 503 Gas Line lnsp
Mechanical lnsp
Reg #: LIC 115110 Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -00
OIS
Issued By: 41. L rda d_ Permittee Signature: C,` •Li .
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
IVI1612003 11:52 5039821603 CASCADE CHIMNEY CARE PAGE 01
-
mocha Permit
Per
lication koh: of flt1 I,l °Nsl
Cit of Tigard , ," , v4 5 d
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Oregon 97273 OCT 7
1 1003 p
'risen!, ore Review
Building
Phone: 503-639-4171 Permit No.:
P
rOCt: Fax: 50 g� • Omer
R'ww.ci. ri
3-398 1
�t'd•or.tu CI F • • hour Iuipectien Request: �.3 CITY C IG4 • i.1 j, j • t -� aw P �t tv..:
i , attDude 24. : 6951111111111111111
1.
■ New construction ,
II De Mechanical �; "" 1: • e
1:1 Addttiotvalterati : ' ' $
once la aem en I ` *T. ��
'' ::. • .. 'r ''! - :' � t � Other: performed. Indicate lea are b tsed on the to values ache 1 & 2 - Farad O 3 " { '' ` ormed materials, value (rounded to the nearest dollar) f
Far d dwelli . /! Comrtt c,�it+Uirtdus trial valeta: s °� mot lab or, overhead
IN Accra • Build' • , � and praflt.
IN Master Builder r,T -�•—. _ Sts >'a;e 2 for ]lire 9ca•dute
•rte !■ O ther: . era 1f
Job site ad { t 9' 1 ).J..10 Into' lug „' *id ”" L pant • tee
�
dress: t a
Bid: / �� F
Gas him • . , d •on arco_ bitionin •• 14.00
,Project Name
• t. #: Duct work 14.00 all
Suite #:
Cross street/Directions Reti • to job sits: 14 .• ' ie hot waters em 14.00
Ail boiler 1 a
(for radiator or h • • n c . It 10
Unit heaters (ft ei, not electric)
itt wall dm-du tut • . etc. la 00
Flue/vent (for Wry of Atha) 10.00
Subdivision: Lot #: - ' p i
• 12.15
'1;,;r .•v`.. �'i:., u .e+t • . ..OP •QRIC'; .•••,`:.....i..1,, ,y water heater r. Rret . • ae �
.':•', Macs moo
5 a . / / t r! 10 -00
I �A 10.00 IIIIIIIE
11.00 --
urine iacr/flueivent 1
ird id si ^— ! gNi$ • ! 10 OMME
ante: „ a 10.00
, a.3 ' Ruse hood/other kite en equipment 10.00 MIMI
Address: _.�`j ca
City/StagZip: 1- W clothes dryer exxtwrt 0.00
Phone: .5?, - :. �. Fax: I Slagle duct exhaust
��-� T. (bathrooms, toilet compartments,
�_� :d ., `' 1' :'.,;', ,,,„ • LA : , : 117i al room
utility roo 6,00
Name: 'D0 Maier Atedaswi • fans 10.00
Address: - P.O. au 7 15 ' other: 1 0.00
Ci /State)Zi i : 7Qi � ?rb bas
fL�•Q.C�, A. 0!29 P. s. .40 tor rare 1, st.fla.uh addition
Phone: 3,i 3,i4.1 ~112 y , Fax: . 0-3: , Fu , etc. ••
E-mail' IIII
••
a
t .. • - unit heater • •
WaIV. .
. ' .:i, Water heater III. ..
iii .
Buaiaesa Name: Case 0 e• .11 u 0 • / - FUtplace ••
Address: P. 77 ` ••
Citv/State/Zi • : - , acI,K, ,• £. 97' a3 B_• .•
Phone: 50 - 3Cr - C►othr a
Fax: A �:.,, -) b�3 ira
CCB Lie. #: i f S OS
wuthortzed miumiiiiiiiiiiiiime
Signature: Date IO- lG O � IM Per
trot /l Minimum Peut ae $72.50 a
Q e r e / /" Plwn Review Fee 3% o permit Foe
(Please prim name) t - s 8% o£Pemtit Feta 1.1111M
470r
Notice: 114 permit application ' 11 A r•rmlt is not Obtained within
'beer m•th•dowev en by t4Cgaty autld'ipa Induce.). : lee acrd.
180 days attar It has bun accepted as romping. ' S :e plan required lbr cawing' A/C setts
i :1Fbts\P' /WM Pc.rts‘MarerntACp.dOe 01/03